By the numbers

$940 million

Cost of facility, about half funded from $496 million general obligation bond issue passed in 2004, $150 million revenue bonds, $60 million capital fundraising campaign and remainder from ongoing revenue and savings

$300 million

The gift necessary to secure naming rights for the entire hospital campus.

Pal-O-Meter to poll construction workers on conditions at the job site

Green roof, ‘Bonsaied’ trees part of landscaping design

By ROGER SHOWLEY

Palomar Medical Center West isn’t just about patient rooms, operating tables and medical wings. It’s also about creating an environmental setting through the use of trees and plants, said the project’s landscape architect, Andy Spurlock.

“The nurses really championed the idea of having the landscape serve their program,” he said.The result, a $1 million installation by ValleyCrest Landscape Cos. of Calabasas, is a veritable forest, from 1-gallon shrubs to 60-inch boxed tree specimens.

Apart from the usual greenery at ground level, the hospital will sport the county’s largest green roof: 2 acres of succulents on the undulating roof of the surgical wing.

It won’t be accessible to the public.On each floor of the 11-story nursing tower are three planted areas, including places for trees set into 4-foot-deep concrete containers, lined with multiple layers of waterproofing. Over time, the trees will reach the terraces above and resemble something like the floating forests seen in the movie “Avatar.”

“We were anticipating ‘Avatar’ but hadn’t seen it,” Spurlock said. “Looking out on one of the terraces, you’ll look at the canopy of a tree.”He said the restricted growing space will limit each tree’s height and growth.“The trees will be bonsaied over time,” he said.

In picking individual flowers and shrubs, Spurlock paid attention to any that might aggravate allergies; none will be located in gathering places or walkways.

“We gave consideration to the medicinal properties of plants,” he added. “A surprising number are used for landscaping as well.

”But among the options discarded was the inclusion of edible plants and fruit trees.“We have herbs,” he said. “But the maintenance staff didn’t want to deal with picking up fruits that might be rotting or decaying or trying to use or display them.

There was a thought about having active gardening as a therapy, as some hospitals are doing. That’s not in the design now.”

It’s like a giant Erector Set on the western Escondido skyline -- an 11-story steel framework rising more than 200 feet above a hill off Auto Park Way and Citracado Parkway.

But halfway to completion, the $940 million Palomar Medical Center West — the largest private construction project in the county right now — is looking more like a hospital as 800 construction workers begin to frame in the 360 patient rooms, 60 emergency rooms and 12 operating rooms.

The details of the hospital, said to be the largest under construction nationally, are being closely watched by other hospitals and major infrastructure companies and institutions. More than 500 people have toured the site during construction, many from the health care management and design industry.

Palomar is testing the latest technology, space planning and best construction practices in the business. The Center for Health Design calls it the first “fable hospital” because it is incorporating all the latest thinking into one project. It’s a pilot project in the Green Guide for Healthcare rating system and following the draft guidelines for LEED for Healthcare. LEED stands for Leadership in Energy and Environmental Design, sponsored by the U.S. Green Building Council.

The U-T tagged along on a hard-hat tour by several key hospital and construction officials.

First impression: The dirt parking lot off Citracado Parkway looks like a car rally’s about to commence. There’s a tent in the distance (where construction crews eat lunch or buy from a lunch wagon), and at one side a line of trailers where contractors meet every morning and afternoon to check the day’s progress and plan the next day’s workload.

Workers are unpackaging prefabricated exterior panels, assembled in China from American-made parts. The 5-foot-by-15-foot unitized panels, made of fiber- reinforced cement and glass, cover the nursing tower and are designed to fit together with no more than an 1/8-inch tolerance.

The fit has been so perfect that installation is going three times faster than anticipated, and not one panel has been rejected for imperfections — though several have been discarded because they broke in transit or on the site, Gracz said.

“They are pretty much indestructible,” said Chessum. “We expect them to be virtually maintenance-free.”

No solar panels are in sight to provide electricity to the building.

“It was considered,” Chessum said.

But the 20-year payback could not be justified — and the electrical generation would have been minimal compared to the massive power requirements of a hospital. Still, Chessum said, when future parking garages are built, solar panels may prove feasible.

Biggest visual surprise: An undulating roof above the two-floor surgical wing. This 2-acre space is covered in dirt in advance of the installation of a succulent garden that will act as a green roof for the building. (CLICK HERE to read more on the landscaping.)

The undulations have a practical as well as aesthetic purpose — practical, because the pipes and ducts for the surgical wing are routed through the high points beneath the roof, and aesthetic because the roof mimics the surrounding landscape of hills and valleys.

Hospital lobbies are where visitors and patients first adjust to the environment of a medical facility — full of hope and trepidation, depending on circumstances.

It’s too early to judge Palomar West, but the space in the framing stage is still impressive: three stories and 50 feet high, a place that takes your breath away in the same way entering a hotel’s soaring atrium signals a special place.

Up one of four construction elevators to the 10th floor of the nursing tower. The windows are not yet installed, so the view is unobstructed to the north.

But what catches the eye are spray-painted red blotches on portions of the steel beams with the words stenciled in: “Protected Zone: Make no attachments to structural steel in the painted area. Do not drill, bolt, rivet or weld.”

These warnings relate to beams’ function to allow the building to sway during an earthquake. Structural engineers don’t want the beams’ integrity to be compromised if holes are drilled in to attach another building member.

On the building’s roof are a helicopter pad and an oversized elevator for transporting patients from the copter to the emergency room. Workers off to one side are receiving one of the exterior panels, delivered by a roughly 280-foot crane and then slipped, and pounded into place. It’s a tight fit.

Patient’s room: The tour continues at the fourth floor, where a typical patient room has been built out to test the details in what is called an “acuity adaptable patient care” model — in other words, making the patient, family, doctor and nursing experience as smooth and anxiety-free as possible. That includes putting the bed, bathroom and medical connections in exactly the same spots in every room. Hospital space planners believe this approach will minimize medical errors or delays because the doctor or nurse can’t find a switch or piece of equipment. Best feature — a large picture window overlooking the countryside.

One innovation already evident on the patient floors — no central nursing station. Instead, nurses will be based at individual work stations, where they can monitor two patients at a time.

Operating rooms: At ground level are the emergency and operating rooms, the heart of any hospital, where time is of the essence and the most equipment is at hand to treat the most complicated trauma.

Dozens of construction workers are installing ducts, pipes and electrical lines that will serve the doctors and nurses when the hospital opens in two years. But what is striking about these spaces is that when they are in operation, the medical staff and their patients will be able to see daylight through windows on the exterior and courtyards on the interior. Doctors and nurses will know night from day.

Final stop: The basement and one of the more unexpected sights.

In one room is a spaghetti-like collection of pneumatic tubes, twisting and turning around each other. This 19th-century invention has been superseded by such communication systems as the telephone, Internet and courier service in most businesses. But it’s still popular in hospitals as a way to transport medical devices and packages from storage rooms to nursing stations.

“It’s very fast and very reliable,” said Chessum. “It’s the best system there is.”